I sent a donation last year after you helped me with information and reassurance. I'll follow through again, but I'm in desperate need of solid info to get me through the next few days.

I'll be brief. I'm male - cunnilingus with a woman of unknown status after I had bitten my lip about an hour earlier. Stupid, I know.

2-3 weeks later I have a rash on my stomach, and one day of vomitting and diarrhea, and one terrible night of profuse sweating. The sweating has subsided at least, but the rash remains.

I'm getting tested next week, but can you offer me some good info (risks, etc.) in the meantime?

As always - you are wonderful and thank you.

Tom

Response from Dr. Frascino

Hi Tom,

Even with a bitten lip, the chances of contracting HIV from cunnilingus remain exceedingly low. (See below.)

"Symptoms" are notoriously unreliable in predicting who is and is not HIV infected. Focus only on your level of risk, not the presence or absence of symptoms.

A single HIV test at the three-month mark will give you a definitive result.

Thank you for your past generosity and desire to make another donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck karma that your conclusive three-month HIV test remains negative.

Good luck. Be well!

Dr. Bob

cunnilingus
Sep 18, 2008

Hello Dr. Bob

I went down on a female in Hong Kong six weeks ago. I had a canker sore in my mouth that popped a day or so before the episode. I also vomitted a couple of hours before from eating some horrible food. As you can tell this was a great night for me. Does any of this constitute having abrasions or cuts in my mouth. I have read that there are no cases from cunnilingus and then I read there are a few cases reported. Which ine is it. How many case are there? I can't sleep and I lay in a pool of sweat every night. I have gotten tested. There was no blood visible form her. I did lick her clit pretty vigorously and wonder if that makes the odds even more? I plan on making a donation and thank you for your time.

Response from Dr. Frascino

Hello,

The risk of HIV transmission/acquisition from cunnilingus is extremely remote, baring extenuating circumstances (see below). Vomiting would not constitute an extenuating circumstance. Canker sores in the mouth are generally fairly superficial and heal quickly. Without examining your specific canker sore, I cannot advise you if it was significant enough to constitute a risk. However, since it "popped a day or so before the episode," I would assume it was well along in its healing process, thereby decreasing any HIV risk. As always, if you're concerned that you placed yourself at risk for HIV, get an HIV-antibody test at the three-month mark.

As for cases of cunnilingus, the discrepancy has to do with "documented cases" versus "case reports." Case reports are merely anecdotal reports in which the patient claims that was their only HIV risk behavior. A "documented report" has more stringent requirements, such as would be the case in a clinical trial. No matter which definition you use, the HIV risk related to cunnilingus remains exceedingly low, baring extenuating circumstances, OK?

I know that lots of guys probably asked u this, but I was interesting in your opinion on the next matter: I started doing the foreplay thing with one girl that I met, she had a quick change of mind during the cunnilingus and decided to stop the whole thing..yea very humiliating by the way. I was a bit drunk at the time so I forgot the she had, while not a addict herself,a boyfriend who`s a reall junky (needles and stuff), so finaly my question whould be: should i get tested? I`am not asking that just for a peace of mind, but i want to a doctors point of view..is it posible that I got infected from that contact?

Second, yep! very humiliating indeed! Maybe you should check your technique (or wait until you have your braces removed)???

Dr. Bob

Each night I wait up till you make your posts. (CUNNILINGUS) Aug 14, 2008

First of all let me say this is the only place I would trust the information that is given and I think that is why so many come here for answers to their worries. I have written to your forum a couple of times and was not able to get an answer to any of my questions. Perhaps my problem is trivial to the questions asked by others, but none the less still troublesome for me. I am almost 60 years old. I have Sjogren's Syndrome and test postive for both the SSA and SSB antibodies. I also have had surgery to my prostate and am pretty much impotent. Recently, after a couple of years of no sex, met a lady and performed oral sex on her. I got little from this other then making someone else feel good. Before this I was HIV negative and hope I still am. This is the only exposure I have had in at least two years. A couple of days after this exposure, i expereinced terrible stomach problems and persistent headaches. I went to a clinic and they did a CBC and found my WBC to be slightly elevated, and prescribed me Two antibodics (Cipro and Flagll) with a diagnosis of diviticulits. I often have bouts of slight pain in the area of my parotid gland even before this exposure. I went to my Rhuematolgist and was tested for CBC with differential and other tests specific to other autoimune problems such as Lupuse, etc. The only thing that came of that was Vitamin D deficiency and positive for SS. I am however feeling uncomfortable in the left side of my neck, left arm pit and left groin area. Laying down and getting rest, or after a nights sleep, relieves these symptoms and everything starts out fine but as the day progresses my left parotid gland area, feels puffy, and tender, then later in the day the groin will really start to hurt. My head itches a a lot at night, and I am using a medicated shampoo to relieve this but still iches. I have had no fever, night sweats, or other problem and it has been two months since my exposure. Here are my questions: 1. Does someone with SS have a greater chance of becoming infected from a low risk exposure such as mine. 2. Can the nodes come and go each day or would they be swollen constantly ( I have never ever felt a node but they do hurt in the area they would be found). 3. If one has such symptoms and is indeed infected would he test postive at that time. 4. Would someone who takes plaquenil for SS experience less symtoms then someone who does not take any medicaations.

Response from Dr. Frascino

Hi,

Before addressing your specific questions, I'll point out a few facts. First of all, the symptoms you experienced "a couple of days" after your "lunch at the Y" (cunnilingus) would not be HIV related. Acute retroviral syndrome (ARS) symptoms take weeks, not hours or days, to appear. Second, cunnilingus carries an extremely minimal risk for HIV transmission. (See below.) Third, swollen lymph glands related to HIV disease would not be limited only to one side of the body. The virus quickly spreads throughout the body and therefore the symptoms would be generalized, not unilateral.

Turning to your specific questions:

1. No.

2. Lymphadenopathy associated with HIV is a more constant phenomenon. I do not believe your symptoms are HIV related.

3. HIV-antibody tests taken prior to three months are not considered to be definitive, symptoms or no symptoms.

Guess you could probably use my symptoms as a textbook example of the symptoms can't you doctor?

Do I even need to get tested or is it a surety that I am HIV positive?

Response from Dr. Frascino

Hi,

Actually I could probably use you as a "textbook example" of someone convinced he is HIV positive when in reality he is not. Dude, I've said it before and now I'll say it again: Symptoms, no matter what they are, are notoriously unreliable in predicting who is and is not HIV infected. The only way to determine HIV status is to get an HIV test. Period.

My advice is to get a rapid HIV test. You'll have a definitive answer in as few as 20 minutes. Statistically the odds are astronomically in your favor that you did not contract HIV from your "lunch at the Y."

My bet is that the next time you write in the title of your post, rather than "The Perfect Symptoms," will be "The Perfect WOO-HOO!" And then I could use you for that "textbook example" I mentioned. But if you peruse the archives you'll find I've already got gazillions of other "textbook examples" identical to you! So join the crowd of ex-worried wells, OK? So what are you waiting for dude? Get moving! Get tested!

Dr. Bob

scared and confused in uk! (CUNNILINGUS) Jan 31, 2008

super bob!! all was well until a few days ago, could you help me out with this one,? i performed a sesion of clit licking on a lady of unkown status, my tongue never penatrated her just liked her clitoris, i had no cuts or nicks in my mouth that i could see, do i need a test for hiv, i know your the guru on this my freind, ill send a donation anyway as your cause touched the lives of so many people thanks dr your the man misguided in limey land!

Response from Dr. Frascino

Hello Misguided in Limey Land,

Cunnilingus carries a negligible risk for HIV transmission. The main reason for you to consider HIV testing would be to put any residual fears you might be harboring permanently to rest. The HIV test results will undoubtedly be negative. I'll print some information below from the archives that addresses the issue of HIV risk associated with cunnilingus.

Thanks for your donation mate! Cheers!

Dr. Bob

unprotected cunnilingus Jun 28, 2007

Yo Bobby!!!

Let me begin by saying how much I love this site. I'm currently working abroad and unfortunately have no peeps I would feel comfortable disclosing my HIV concerns. I plan on making a donation upon my arrival back to home. Ok... on to the good stuff. I'm a 26 year-old heterosexual male living in Japan. I've been tested twice over here for a multiple STI's including HIV and have thankfully tested negative each time. My concern is that recently I had an encounter with a Japanese women. I asked if she had ever been tested and she responded no. A bit worriesome but unfornately not uncommon in Japan. We had sex with limited penetration (Unfortunately she could only stand the the girth of my manhood for a few moments :(). I used multiple condoms provided in the love hotel (for multiple attempts, lol). However, I did perform unprotected cunnilingus on her at least twice and for an extended period of time (1-5) minutues. I didn't notice any sores, there was no blood, my good oral health on my part, and she showered and cleaned her vagina beforehand. It's been 2 weeks since this encounter and I have developed a white tongue with painless white rings and I am freaking out!!!! As a result, I am losing sleep and appetite and I am terrified everytime I get a headache or feel discomfort. Here are my questions - (1) What are the current risks of contracting HIV from a heterosexual women in Japan who is not a sex-worker? (2) Should I be concerned and hence get retested for HIV keeping in mind that I recieved a negative test result 1 month ago and 7 months ago? (3) I'm aware that oral thrush is common in HIV patients but is it a symptom that will show 2-3 weeks after exposure? (4) What is the rate of cunnilingus transmission? (5) What is the rate of unprotected fellatio transmission (for the receiver)? (5) Although I am unaware of the quality of the condoms at the love hotel (there were colored and thin) - they looked like flavoured condoms. The condom did not break or slip off - what are the chances of transmission via flavoured condoms? I have read some horror stories on the internet concerning HIV transmission over here even though from all the statistics the rate is extremely low here (at least reported rate). I've been tested 2 times this year and I am worried if I show up a third time they'll offer me a straight jacket with the free condoms!

Ease my pain!

Big Boy

Response from Dr. Frascino

Hi Big Boy,

Let me guess. You're nickname in college was "beer can," right???

OK, on to your questions:

1. Sorry, a specific HIV-transmission risk statistic for "heterosexual women in Japan who are not sex-workers" doesn't exist any more than a specific statistic for "bisexual cross-dressing Mormon midgets with webbed toes in Salt Lake City".

2. Assuming the latex condoms stayed on the "beer can" and did not break, your HIV risk would be limited to cunnilingus on a partner of unknown serostatus. This carries a negligible risk for HIV transmission. (See below.) HIV testing would be primarily for peace of mind.

3. I doubt you have thrush. It is not common two-three weeks post-exposure.

4. See below.

5. The estimated per-act risk for acquiring HIV from unprotected insertive oral sex with a partner confirmed to be HIV positive is 0.5 per 10,000 exposures.

6. Depends on the flavor! Why not bring your own condoms (the extra girth variety) next time you visit the love shack?

Dude, relax! Your level of worry is way out of proportion to any real risk!

Dr. Bob

Oral Sex question...Pls Pls answer!! (CUNNILINGUS) Apr 24, 2007

Hello Dr. Bob,

About 3 months ago I asked you a question and you responded, which was awesome! I feel like I am talking to a celebrity. I really admire you and all that you do. I know I said I was going to send a donation and I will I promise as soon as I get back to the states next month.

Anyways, my question is regarding HIV and oral sex. I know by reading in the archives that it is a low risk but for some reason I keep on worrying.

Here is what happened. I was with a Romanian sex worker. We had protected intercourse and at the end I performed unprotected oral on her. I didnt notice any open sores or anything unsual down there. After the act I checked my mouth for any open sores and I dont recall seeing any. I also washed my mouth out and when I got back I brushed my teeth. However, I did notice two small canker sores, one on the side of my tongue and the other at the bottom of the inside of my lip. Could any HIV-infected fluids gotten in there?

I assume she was HIV negative. Before and after the act she washed both hers and mine genitals and seemed to be really cautious. As for transmission, is the risk of getting HIV from vaginal fluids lower than from Semen? Does it have to be an open sore in the mouth to get infected? I know blood is the riskiest way as is unprotected anal and vaginal intercourse. Also, does saliva contain agents that help kill the virus?

I would really appreciate it if you could answer this one question for me, I promise this is the last time you will get a question from this worried well. Take care and god bless!

Mikey the Sailor

Response from Dr. Frascino

Hey Sailor-Boy Mikey,

The risk of HIV transmission from cunnilingus is extremely low. (See below.) Even with your two small canker sores, I would put your HIV risk in the remote-to-nonexistent category. Certainly if you're worried, get a rapid HIV test at the three-month mark to put your residual fears permanently to rest. Undoubtedly the result will be negative, but just to be extra sure, I'm sending you my best good-luck karma, OK?

Regarding saliva, yes, there are substances in salivary secretions that inhibit HIV. As for the infectivity of vaginal fluids versus semen, that depends on viral load, viral strain and many other factors.

Hey bob, your the best! Well i finally did it, went today and was tested for all sti's including HIV. Im studying in another country and have no one to share the stress of this with. Heres my story...... A few of months ago i performed unprotected cunnilingus. Stupid now i know but i thought this was a safe practice at the time. It lasted for a mere 45 seconds at most. A couple of days later, i came down with chills,which subsided within a day or so. I also had a chesty cough and swollen glands under my chin, which lasted for a week at most. I thought nothing of it at the time as i had just started college and everyone i knew was down with the flu. Then 2 weeks ago (a few months after my exposure) i had some unusual white discharge after urination. This got me worried about gonorrhea and chlamydia, ive been to the toilet several times since and nothing! Anyways today i went to my local clinic in order to put my fears at rest. I honestly didnt think they would test for HIV, but they said i should, so i went along with it. This has got me rather spooked to say the least. My questions are- 1-What do you think my chances of catching HIV from this one off brief exposure? What are my chances of dodging the HIV bullet Dr Bob? Secondly do you think the one episode of discharge indicates gonorrhea or chlamydia? Can symptoms appear month later and only occur the once? Im making a donation to your wonderful cause, will you please send me your goodluck karma in return! Thank you, stay well, Ewan

Response from Dr. Frascino

Hello Ewan,

I'll proceed directly to your specific questions:

1. Negligible (see below).

2. Excellent.

3. Probably not, but you're getting tested anyway, so you'll have a definitive answer very soon.

4. Extremely unlikely.

5. Good luck karma signed, sealed and sent.

Be well. Stay well!

Dr. Bob

Tonsils and Oral Sex (CUNNILINGUS) Sep 30, 2006

Dr. Frascino,

You are definitely a person admirable character. I have just donated $50 to your wonderful foundation. I wish I could afford more at this time, but money is very tight on my end with my graduate school studies. Like everyone else, I have a question for you.

I performed unprotected oral sex on a woman of unknown status about 2 weeks ago. I purposely avoided unprotected intercourse because of its risk. However, I am know concerned about this oral sex episode. I have recently developed enlarged tonsils and my tests for sterp have been negative. I have a sore throat which is understandable, but no other symptoms. I have tried to use your past answers of similar exposures to help ease my anxiety. But there is just something about hearing it directly from you.

Have you ever seen a person with whose only exposure was unprotected oral sex on a woman test positive for HIV?

I hope that your good health will continue to remain. I promise I shall make another donation later on this year.

Thank you,

Kenny

Response from Dr. Frascino

Hello Kenny,

Unprotected cunnilingus on a woman of unknown HIV serostatus carries only a negligible risk for HIV transmission. (See below.)

To answer your specific question, nope!

Thanks for your kind comments and donation.

Stop worrying! If you can't stop worrying, get tested at the three-month mark, but do realize the primary reason to do so would be to put your unwarranted fears permanently to rest, OK?

Good luck. Stay well.

Dr. Bob

Oral Sex and HIV

Feb 18, 2006

i have just stumbled on this site, and would like your opinion, on jan 1st 2006 i had protected vaginal sex with a prostitute, but i performed unprotected oral sex on her, before i performed she whiped her virgina and when performing oral sex i could taste no secretion or menstural blood, immediately afterwards i realised what a rediculous thing i had done and became increasingly paranoid about the possibility of HIV infection, on the 3rd of Jan i started on 28 PEP course, what do you think my chances of having HIV are, alot of other sites i have been on say Cunnilingus is Low risk, some say no risk, quantatively what is this risk? i am due to go for an HIV test at the end of march and am petrified of the result, many thanks

Ben C

Response from Dr. Frascino

Hello Ben,

She "whiped her virgina?" Would that be "whiped" as in whipped or "whiped" as in wiped? And would that be "virgina" as in Virginia or "virgina" as in vagina? I would assume "whipped" and "Virginia" are out, because nothing kinky ever happens in that state. The risk of HIV transmission from cunnilingus is extremely low. I'll post a question from the recent archives that addresses this problem. (See below.)

I do not believe PEP was warranted for your potential exposure. There is no reason to be "petrified" of your HIV test results. I see nothing but good news heading in your direction. I suggest you begin practicing your WOO-HOOs!

Good luck.

Dr. Bob

Cunnilingus - no blood, good oral healt Jan 12, 2006

Dear Dr. Bob,

Just sent a donation of 200 dollares - thanks fo you help - people need it and now i feel i need too

You had answered a number of questions related to the risk of cunnilingus. I was engaged in one 2 months ago but no blood was involved and my oral helth is ok. The experience was with the mistress and when i asked her afterwards she told me she is DD free .What concerns me that you mentioned once that the probability of getting HIV in this case 0.5 per 10000 cases. doest it mean that there is 1 possible transmission in 20000 cases. a number of cunnilinguses given is much more then that and there are no documented cases so far. How do these 2 things reconcile?

I am still concerned although i understand i should not be....you know...

How is it possible generally to get HIV via giving cunnilingus in case when there is no blood and my oral health seems to be in order. Appreciate your reply.

I have another general question re the symptoms...

It seems that in case there are symptoms there are ususally more then one should be present based on the statistics you posted earlier.

Appreciate your reply

Thanks for the help

Response from Dr. Frascino

Hello,

The estimated statistical per-episode risk of 0.5 per 10,000 exposures for unprotected oral intercourse refers to fellatio (oral sex performed on a man), not cunnilingus. The cunnilingus figure would be much less. In fact, it's so small it's difficult to quantitate. There are only very few cases of HIV transmission resulting from performing oral sex on a woman that have been reported to the CDC. Considering we've been monitoring this epidemic for over two decades, that alone is excellent evidence that the HIV-transmission risk through cunnilingus is extremely low. There are a number of scientific hypotheses as to why this is true, but the bottom line remains the same: it's an extremely low-risk activity. (Note: the risk increases if the woman is menstruating and/or the person performing cunnilingus has oral mucous membrane sores, abrasions or inflammation.)

Regarding your second question, ARS can be quite variable in scope, number and severity of symptoms. However, yes, generally more than a single symptom is present.

Thanks for your generous donation!

Stay well.

Dr. Bob

Update from Tonsils and Oral Sex (Cunnilingus) Dec 14, 2006

Dr. Bob,

Thanks for responding to my previous question entitled Tonsils and Oral Sex (CUNNILINGUS). May I woohoo based on the following tests and events:

I performed oral sex on a woman of unknown status; (she was really hot by the way) After I got home from the encounter I brushed my teeth. Would I be at increased risk for brushing my teeth after I performed oral sex? Could some of her vaginal fluid be still in my mouth then get into my bleeding gums when I brushed my teeth? I have a feeling this is a stupid question.

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